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243 FINAL > Allergic Rhinitis 1: Pathophys, Symptoms, Non-pharm > Flashcards

Allergic Rhinitis 1: Pathophys, Symptoms, Non-pharm Flashcards

1
Q

Allergic Rhinitis (AR)

Affects __-__% of population

A

10-30%

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2
Q

Allergic Rhinitis (AR)

Which group is the highest prevalence increasing?

A

School-aged children (due to hygeine hypoth)

We are sterilizing and cleaning a lot more
Immune system not challenged enough to develop immunity

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3
Q

Allergic Rhinitis (AR)

What are the genetic components?

A
  • 30% chance of developing allergic rhinitis if one parent is affected
  • 50% chance if both parents are affected
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4
Q

Allergic Rhinitis (AR)

What is AR associated with?

A

asthma, atopic dermatitis, and food allergies

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5
Q

Allergic Rhinitis (AR)

When will it occur?

A

after inhalation of an allergen which causes inflammation of the nasal mucosa

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6
Q

Allergic Rhinitis (AR)

What are the 2 types of rhinitis?

A
  • Non-allergic

* Allergic (IgE mediated)

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7
Q

Allergic Rhinitis (AR)

List the non-allergic rhinitis

A

• Drug-induced
• Hormones (pregnancy, menstruation, hypothyroidism)
• Infection
• Non-allergic rhinitis with eosinophilia syndrome (NARES)
• Other: emotions, vasomotor rhinitis (exercise, cold air),
anatomic abnormalities (nasal septal deviation), food and alcohol, nasal polyps, foreign body, strong odours

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8
Q

Allergic Rhinitis (AR)

List the Drug-Induced Non-Allergic Rhinitis

A
  • ACE inhibitors
  • ASA and other NSAIDs
  • Cocaine
  • Diuretics
  • Gabapentin
  • Hydralazine
  • Oral Contraceptives
  • Phosphodiesterase -5 inhibitors (eg. Viagra ®)
  • Antipsychotics (eg. Chlorpromazine, risperidone)
  • Sympatholytics (eg. Clonidine, doxazocin, methyldopa, phentolamine)
  • Topical Decongestants (prolonged use)
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9
Q

Allergic Rhinitis (AR)

List the 3 ways to classify AR

A
  1. By pattern of symptoms (old way of classifying)
  2. By frequency of symptoms
  3. By symptom severity
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10
Q

Allergic Rhinitis (AR)

Name the 2 types of by pattern of symptoms

A
  • Seasonal: response to seasonal allergens (pollen, grass, etc.)
  • Perennial: response to year-round allergens (mold, dust mites, animals, etc.)
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11
Q

Allergic Rhinitis (AR)

List the ways to determine by frequency of symptoms

A
  • Intermittent: < 4 days per week or < 4 weeks at a time

* Persistent: > 4 days per week or > 4 weeks at a time

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12
Q

Allergic Rhinitis (AR)

How to determine when using by symptom severity?

A
  • Mild: no impairments or complications with sleep or daily activities
  • Moderate to severe: impairment of sleep or daily activities, including cognition/memory
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13
Q

Allergic Rhinitis (AR) (IgE mediated)

What are the 3 phases involved in allergic reaction?

See picture - The Allergic Cascade

A
  1. Sensitization
  2. Immediate Reaction
  3. Late Reaction
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14
Q

Allergic Rhinitis (AR) (IgE mediated)

Name the reactions & symptoms - Sensitization

A

Reactions:
• Allergen first contacts nasal mucosa
• Specific IgE antibodies are produced and bind to mast cells and basophils

Symptoms:
• Asymptomatic

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15
Q

Allergic Rhinitis (AR) (IgE mediated)

Name the reactions - Immediate Reaction

A

Reactions:
•Allergen re-exposure (occurs within minutes and lasts 30-90 mins)
•Allergen binds to specific Abs on immune cells
•Allergic mediators (histamine, leukotrienes, prostaglandins, TNF-a, kinins) are formed & released

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16
Q

Allergic Rhinitis (AR) (IgE mediated)

Name the symptoms - Immediate Reaction

A
  • Sneezing
  • Nasal and palatal pruritus
  • Congestion
  • Clear rhinorrhea
17
Q

Allergic Rhinitis (AR) (IgE mediated)

Name the reactions & symptoms - Late Reaction

A

Reactions:
•Symptoms occur 4-8 hrs after re-exposure
•Migration of basophils, eosinophils, macrophages, monocytes, and neutrophils into the nasal mucosa
•Leads to prolonged symptoms of inflammation, nasal blockages, and chronic ongoing rhinitis

Symptoms:
• Immediate phase symptoms but nasal congestion predominates

18
Q

Allergic Rhinitis (AR) (IgE mediated)

What are other symptoms?

A
  • Itchy, red, watery eyes (allergic conjunctivitis)
  • Itchy throat
  • Ear fullness and popping
  • Feeling of pressure over the cheeks and forehead
19
Q

Allergic Rhinitis (AR) (IgE mediated)

List the effect on quality of life

A
  • Lower overall sense of health than those without
  • Headache, difficulty concentrating, low mood, fatigue, or sleep disturbance
  • Children can present with malaise and fatigue
20
Q

Allergic Rhinitis (AR) (IgE mediated)

What are the complications?

A
  • Sinusitis
  • Otitis media
  • Asthma
  • Sleep apnea
  • Dental overbite and high-arched palate in children due to chronic mouth breathing
21
Q

Allergic Rhinitis (AR)

List the goals of therapy

A
  • Prevent symptoms by avoiding exposure to allergen(s)
  • Alleviate signs and symptoms produced by the allergic response
  • Minimize adverse effects of treatment
  • Improve quality of life
22
Q

Allergic Rhinitis (AR)

How to assess AR?

A
  • Identify duration, frequency, and severity of symptoms
  • Identify any precipitating factors, allergens, and occupational exposures
  • Identify any personal or family history of allergies or atopy
  • Identify previous therapies tried and response
23
Q

Allergic Rhinitis (AR)

When to refer?

A
  • Medications used for > 2 weeks without adequate response
  • < 2 years old
  • Unable to identify allergen
  • Signs and symptoms of otitis media, sinusitis, asthma, COPD, other infections
  • Fever, purulent nasal or ocular secretions, facial pain
  • Loss of smell/taste
  • Recurrent epistaxis
  • Unilateral symptoms
  • Moderate/severe symptoms in some cases
24
Q

Allergic Rhinitis (AR)

List the Non-Pharm management

A
  • Environmental controls and trigger avoidance = 1 st step in management
  • Nasal saline irrigation
25
Q

Allergic Rhinitis (AR)

List the Prevention/Trigger Avodiance (RxTx)

***See slide for additional info

A
  • Pollen
  • Outdoor molds
  • Indoor molds
  • House dust mites
  • Animal allergens
  • Occupational allergens
  • Others - avoid tobacco, insect sprays, air pollution, freash tar, or paint; HEPA fitlers
26
Q

Allergic Rhinitis (AR)

What can nasal saline irrigation do?

A
  • It can reduce symptoms and need to pharmacologic therapy

- Isotonic saline preferred over hypotonic (improves mucociliary clearance)

27
Q

Allergic Rhinitis (AR)

List the nasal saline products

A
  • NetiPot®
  • NetiRinse®
  • Hydrasense®
  • Normal saline spray

243 FINAL (24 decks)

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